Prospective Assessment of Fatigue and Health Status in Greek Patients With Breast Cancer Undergoing Adjuvant Radiotherapy

Maria Lavdaniti

Elisabeth Patiraki

Urania Dafni

Maria Katapodi

Elizabeth Papathanasoglou

Anastasia Sotiropoulou

ONF 2007, 33(3), 603-610. DOI: 10.1188/06.ONF.603-610

Purpose/Objectives: To describe fatigue in women with breast cancer undergoing radiotherapy and to explore the impact of fatigue on their health status.

Design: Prospective, descriptive, repeated measures.

Setting: A major oncology center, Saint Savvas Cancer Hospital, in Athens, Greece.

Sample: Consecutive sample of 106 women (mean age = 55 ± 12), with histologically confiormed diagnosis for stage I or II breast cancer who were receiving adjuvant radiotherapy for approximately six weeks.

Methods: Data were collected with the Revised Piper Fatigue Scale (PFS) and the Short Form-36 (SF-36) Health Survey Scale in the first two days of radiotherapy (T0), during the third week (T1), and during the last week of treatment (T2).

Main Research Variables: Fatigue, health status.

Findings: Across-subjects analysis revealed that fatigue increased during radiotherapy in patients with breast cancer regardless of stage, type of surgery, or whether they received chemotherapy (p < 0.05). Between-subject analysis revealed that no differences existed in the PFS between different groups (chemotherapy versus no chemotherapy, breast conservation versus mastectomy, stage I versus stage II) at each measurement point. A negative correlation was found between the subscales of the PFS and all of the subscales of the SF-36.

Conclusions: Fatigue intensity increased significantly during the course of radiotherapy, and patients experienced a significant deterioration in their overall health status.

Implications for Nursing: Findings contribute to the growing body of evidence regarding fatigue and its impact on health status in Greek patients with breast cancer and provide insights for effective nursing assessment, patient education, and symptom management.

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    References

    American Cancer Society. (2006). Cancer facts and figures 2006. Retrieved March 25, 2006, from http://www.cancer.org/downloads/STT/CAFF 2006PWSecured.pdf
    Berger, A.M., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. Oncology Nursing Forum, 27, 1443-1448.
    Bower, J.E., Ganz, P.A., Desmond, K.A., Rowland, J.H., Meyerowitz, B.E., & Belin, T.R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 1, 743-753.
    Broeckel, J.A., Jacobsen, P.B., Horton, J., Balducci, L., & Lyman, G.H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 16, 1689-1696.
    Can, G., Durna, Z., & Aydiner, A. (2004). Assessment of fatigue in and care needs of Turkish women with breast cancer. Cancer Nursing, 27, 153-161.
    Chan, C.W., & Molassiotis, A. (2001). The impact of fatigue on Chinese patients with cancer in Hong Kong. Supportive Care in Cancer, 9, 18-24.
    Christopher, K.A., & Morrow, L.L. (2004). Evaluating a community-based exercise program for women cancer survivors. Applied Nursing Research, 17, 100-108.
    Cimprich, B., & Ronis, D.L. (2001). Attention and symptom distress in women with and without breast cancer. Nursing Research, 50(2), 86-94.
    de Jong, N., Courtens, A.M., Abu-Saad, H.H., & Schouten, H.C. (2002). Fatigue in patients with breast cancer receiving adjuvant chemotherapy: A review of the literature. Cancer Nursing, 25, 283-297.
    Donovan, K.A., Jacobsen, P.B., Andrykowski, M.A., Winters, E.M., Balducci, L., Malik, U., et al. (2004). Course of fatigue in women receiving chemotherapy and/or radiotherapy for early stage breast cancer. Journal of Pain and Symptom Management, 28, 373-380.
    Ferrell, B.R., Grant, M.M., Funk, B.M., Otis-Green, S.A., & Garcia, N.J. (1998). Quality of life in breast cancer survivors: Implications for developing support services. Oncology Nursing Forum, 25, 887-895.
    Geinitz, H., Zimmermann, F.B., Stoll, P., Thamm, R., Kaffenberger, W., Ansorg, K., et al. (2001). Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer. International Journal of Radiation Oncology, Biology, Physics, 51, 691-698.
    Graydon, J.E. (1994). Women with breast cancer: Their quality of life following a course of radiation therapy. Journal of Advanced Nursing, 19, 617-622.
    Graydon, J.E., Bubela, N., Irvine, D., & Vincent, L. (1995). Fatigue-reducing strategies used by patients receiving treatment for cancer. Cancer Nursing, 18, 23-28.
    Greenberg, D.B., Sawicka, J., Eisenthal, S., & Ross, D. (1992). Fatigue syndrome due to localized radiation. Journal of Pain and Symptom Management, 7, 38-45.
    Headley, J.A., Ownby, K.K., & John, L.D. (2004). The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncology Nursing Forum, 31, 977-983.
    Irvine, D., Vincent, L., Graydon, J.E., Bubela, N., & Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. A comparison with the fatigue experienced by healthy individuals. Cancer Nursing, 17, 367-378.
    Irvine, D.M., Vincent, L., Graydon, J.E., & Bubela, N. (1998). Fatigue in women with breast cancer receiving radiation therapy. Cancer Nursing, 21, 127-135.
    Jacobsen, P.B., Hann, D.M., Azzarello, L.M., Horton, J., Balducci, L., & Lyman, G.H. (1999). Fatigue in women receiving adjuvant chemotherapy for breast cancer: Characteristics, course, and correlates. Journal of Pain and Symptom Management, 18, 233-242.
    King, C.R., Haberman, M., Berry, D.L., Bush, N.J., Butler, L., Dow, K.H., et al. (1997). Quality of life and cancer experience: The state-of-the-knowledge. Oncology Nursing Forum, 24, 27-41.
    Longman, A.J., Braden, C.J., & Mishel, M.H. (1997). Pattern of association over time of side-effects burden, self-help, and self-care in women with breast cancer. Oncology Nursing Forum, 24, 1555-1560.
    Miaskowski, C., Dodd, M., & Lee, K.A. (2004). Symptom clusters: The new frontier in symptom management research. Journal of the National Cancer Institute, 32, 76-78.
    Michaelidis, G. (1999). Therapeutic directions in radiation oncology. Athens, Greece: Parisianos.
    Mock, V. (2003). Clinical excellence through evidence-based practice: Fatigue management as a model. Oncology Nursing Forum, 30, 787-796.
    Mock, V., Pickett, M., Ropka, M.E., Muscari Lin, E., Stewart, K.J., Rhodes, V.A., et al. (2001). Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice, 9, 119-127.
    Padilla, G.V., & Kawaga-Singer, M. (1998). Quality of life and culture. In C.R. King & P.S. Hinder (Eds.), Quality of life from nursing and patient perspectives: Theory, research, practice (pp. 74-92). Sudbury, MA: Jones and Bartlett.
    Pickett, M., Mock, V., Ropka, M., Cameron, L., Coleman, M., & Podewils, L. (2002). Adherence to moderate-intensity exercise during breast cancer therapy. Cancer Practice, 10, 284-292.
    Piper, B.F., Dibble, S.L., Dodd, M.J., Weiss, M.C., Slaughter, R.E., & Paul, S.M. (1998). The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25, 677-684.
    Sarris, M. (1999). Quality of life in renal patients. National and Kapodistrian University of Athens, Athens, Greece.
    Schwartz, A.L., Nail, L.M., Chen, S., Meek, P., Barsevick, A.M., King, M.E., et al. (2000). Fatigue patterns observed in patients receiving chemotherapy and radiotherapy. Cancer Investigation, 18, 11-19.
    Smets, E.M., Visser, M.R., Willems-Groot, A.F., Garssen, B., Oldenburger, F., van Tienhoven, G., et al. (1998). Fatigue and radiotherapy: (A) experience in patients undergoing treatment. British Journal of Cancer, 78, 899-906.
    Tountas, J. (2001). Health in Greece. Nea Ygeia, 30, 4-11.
    Triandis, C.H. (1990). Cross-cultural studies of individualism and collectivism. In J.J. Berman (Ed.), Cross-cultural perspectives: Nebraska symposium on motivation (pp. 41-133). Lincoln, NE: University of Nebraska Press.
    Ware, J.E., Jr., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473-483.
    Wengstrom, Y., Haggmark, C., Strander, H., & Forsberg, C. (2000). Perceived symptoms and quality of life in women with breast cancer receiving radiation therapy. European Journal of Oncology Nursing, 4(2), 78-88.
    Winningham, M.L., Nail, L.M., Burke, M.B., Brophy, L., Cimprich, B., Jones, L.S., et al. (1994). Fatigue and the cancer experience: The state of the knowledge. Oncology Nursing Forum, 21, 23-36.
    Woo, B., Dibble, S.L., Piper, B.F., Keating, S.B., & Weiss, M.C. (1998). Differences in fatigue by treatment methods in women with breast cancer. Oncology Nursing Forum, 25, 915-920.
    Wratten, C., Kilmurray, J., Nash, S., Seldon, M., Hamilton, C.S., O'Brien, P.C., et al. (2004). Fatigue during breast radiotherapy and its relationship to biological factors. International Journal of Radiation Oncology, Biology, Physics, 59, 160-167.
    Yan, H., & Sellick, K. (2004). Symptoms, psychological distress, social support, and quality of life of Chinese patients newly diagnosed with gastrointestinal cancer. Cancer Nursing, 27, 389-399.